Fosamax

This may be old information to you folks, but I heard it just yesterday from a friend. She'd gone to an oral surgeon to have a tooth pulled and just that morning remembered to tell him that she was on Fosamax. He told her of 2 of his patients who were taking Fosamax or another durg in that same class of drugs who had osteonecrosis (dead bone) of their jaw bones happen following oral surgery. He refused to remove my friend's tooth and will work with her dentist to help her keep the tooth. The oral surgeon told her that this potential danger would never go away even if she quit taking the Fosamax because the drug would never leave her system.

My friend did an on-line search and found information about this danger. The information was published in the Journal of Maxilofacial Surgeons in Sept. 2004.

Apparently this happens only sometimes and only in the jaw bone. Be sure your dentist knows if you take one of these drugs for osteoporosis.

The plan for my friend is to have her dentist try to put a new crown on it and if that cannot be done, to file it flat since it is still a healthy tooth, just broken.

Sounds like an abcess might put you between a rock and a hard place. If antibiotics couldn't fix it, you might have to take your chances and hope for the best. I'm no dentist or doctor, so have no clue.

I've been on fosomax for 4 years and have had a few teeth pulled and have not had any problem with the bone and gum area healing. It's my guess the necrosis of the jawbone is rare, in the case of fosomax use.

The majority of the cases of osteonecrosis of the jaw have occured in patients with cancer who are on cancer treatments AND are taking a bisphosphonate. The data shows that most of the cases occur with the IV bisphosphonates but there are some reports with the orla bisphosphonates. ALL bisphosphonates have had this information placed in their labels.

It's a very serious problem that most people don't know about Fosamax and Actonel. My friend who was on Fosamax had really bad infections after he had all of his wisdom teeth pulled. He was sick for months. Now, years later, we have proof that the drug he was on made him unable to heal properly. I've also heard that bisphosponates are in our systems for years and years, maybe forever, as someone stated. I've read that too.

Your statement about bisphosphonates being in our system for years and years and maybe forever is not entirely accurate. Here are a few things for you to consider:

1. Fosamax ONLY binds to the active sites of resorption. It does not cover the entire surface of the bone.

2. There are a few different half-lives that you need to know about...Serum, bone surface, and skeletal. As far as bone surface, some of this is covered in #1 and it seems to be only about 10 to 12 days and then it detaches and is expelled from the body. So....the one you are probably worried about in your message is skeletal. Once Fosamax becomes embedded in the bone via bone formation and secondary mineralization, it becomes inactive. At this point, the terminal half-life is due to bone turnover biology. It can certainly become 'active' again once resorption gets to it again. Dr. Gideo Rodan has studied this issue and is an expert in the field...via his research and calculations....after about 10 years, the amount of Fosamax left in the bone is equal to about an one once weekly dose (70mg). Also, after 10 years it has been shown that women who remain on Fosamax have bone turnover levels similair to those seen in healthy premenopausal women. Also, there is no increase in fractures that one would expect if there was oversuppression of bone turnover.

I hope this information helps.

Take care.

Quote:

Originally Posted by Spin444

It's a very serious problem that most people don't know about Fosamax and Actonel. My friend who was on Fosamax had really bad infections after he had all of his wisdom teeth pulled. He was sick for months. Now, years later, we have proof that the drug he was on made him unable to heal properly. I've also heard that bisphosponates are in our systems for years and years, maybe forever, as someone stated. I've read that too.

I've been on fosomax for 5 years, and, during that time have had alot of dental work, from teeth being pulled to root canals to bone grafts to dental implants. I've had no problem with healing and I am a petite, slight person, with osteopenia.

Don't bisphosphantes render natural bone growth, impossible? Don't they kill osteoclast cells, an integral part of the bone building process? One doctor called this, "the violent war approach". Do weight bearing exercises do any good, once a person is on a bisphosphonate? That's what I'd like to know.

There is some indication that bisphosphonates induce osteoclast apoptosis but they mainly prevent the ruffled membrane associated with osteoclast mediated bone resorption.

Your bones stop growing and you reach peak bone mass sometime in your middle to late thirties. This is when bone growth stops. And then from that point on you have a process called bone turnover.....bone absorption followed by bone formation.....Bisphosphonates bring the rate of bone turnover back into the normal premenopausal range. So, I personally don't think that the doctor who called it, "the violent war approach" is really correct and doesn't really understand what happens with bisphosphonates.

Weight bearing exercise ALWAYS is useful. You should always exercise.

Quote:

Originally Posted by Spin444

Don't bisphosphantes render natural bone growth, impossible? Don't they kill osteoclast cells, an integral part of the bone building process? One doctor called this, "the violent war approach". Do weight bearing exercises do any good, once a person is on a bisphosphonate? That's what I'd like to know.

I wonder if it's just genetics because some people never have a problem with low bone density and other people do exactly what is recommended -weight bearing exercise, eating right, etc., and then have bone loss problems. I do hope the PTH nasal spray will be approved and effective as an alternative treatment.

Hello taape - I might have missed something in this thread but what is PTH? I have just recently started on Fosamax (taken once a week and have taken 3 so far) with no side effects but am concerned about all I have read about the possibility of making bones more brittle in the long term. I have told my doctor that I will take it for a year and then, if/when more is known about strontium ranelate would like to try that (at the moment only available in my part of UK on private prescription). I think you are right about low bone density being genetic as I have done all the right things - lots of exercise, good diet, supplements and so on but my mother had very advanced osteoporosis and it looks like I have inherited that but hopefully with better treatment available none of us will ever get to that point.

SusieUK45,
PTH is short for Parathyroid Hormone which is an alternate treatment to biophosphates. I'm using Forteo (brand name) which is a synthetic version of PTH - it helps regulate Calcium levels which is needed for bones to growth and stay strong. It raises the Calcium levels or else keeps them at a postivie level round the clock so bones can grow. That's not a very scientific answer but so far it's helping raise my bone density alot. I still have to eat dietary calcium, take supplements and exercise, etc.,

Your very lucky that biophosphate medication doesn't irritate your stomach. I could tell after 3 pills that I wasn't going to be able to take that medication.